Handover Report: Tossing Out the Tape

Lynnette McCarthy Woodrow BN RN Maureen March RN Maud Crowley RN

Who We Are

St. Clare’s Mercy HospitalCity Hospitals, Eastern HealthSt. John’s, Newfoundland

Objectives

• Review of our issues with taped end of shift

report

• How we changed our model of report

• Challenges

• Solutions

• Evaluation of the change

Enhancing Communication….

Previous: Taped end of shift report

• Content

• Limited Guidelines

• Delay of care

• Dissatisfaction

Our Improvement Aim / Goals

Improve Communication

Improve patient safety

Increase Nursing time at

bedside

Increase Patient

Satisfaction

Our Guiding Principals

ROP from Accreditation Canada

Patient Safety Area 2: Communication

Goal: Improve the effectiveness and coordination of communication among care/service providers and with the recipients of care/service across the continuum.

ROP: The team transfers information effectively among providers at transition points.

Tests for Compliance:

1. The team uses mechanisms for timely transfer of

information at transition points that result in proper

information transfer.

2. Staff is aware of the organizational mechanisms

used to transfer information.

3. There is documented evidence that timely

transfer of information has occurred.

Our Guiding Principals Cont’d

Canadian Patient Safety Institute

“Communication is at the core of healthcare. Because communication can be driven by circumstance or dependent on individual personalities, standardized tools to facilitate effective communication and behaviors represent cogent strategies to support patient.”

(CPSI)

Handover Report

• Combination of verbal and written communication that occurs at various patient transfer points (end of shift; transfers from units, etc.)

Meeting the “Tests for Compliance”

Transfer mechanisms

Staff is aware

Documented evidence

Transfer Mechanisms

Face to Face Verbal Communication

•On-coming/Off-going Staff

•Within Unit – Regrouping

Transfer Forms

Transfer Forms Continued…

Transfer Forms Continued…

Nursing Census

• Computer generated (Meditech)

• Nurse enters data on admission

Transfer Forms Continued…

Unit census includes:

•Basic Patient Demographics

•Admitting Physician

•Admission date and Length of Stay

•Admission Diagnoses

•Past medical History

•Surgery/Procedure(s) since admission

Meeting the “Tests for Compliance” …

Staff Education

• Education Binders

• Emails

• Posters in staff lounges

• Formal and Informal Education Sessions

Meeting the “Tests for Compliance”

Documentation

• Entered in the Document Intervention menu under the Consultation/Collaboration screen of Meditech

Safety Round

First round that staff complete on assigned patient, before obtaining the written component of handover report and includes:

• Check armbands

• Call bell placement

• Proper IV rate and Solution

• Address risk concerns

(side rails, restraints,

brakes)

• De-clutter area

Putting it Together

Unit Specific “Handover Report” Guidelines developed.

Guidelines for Unit Nurses:

• Safety Round

• Patient Care Plans Parts I & II (PACE/DAR)

• Demographics in Meditech

• Verbalization

• Regrouping

• Patient Care Summaries (optional)

• Document Report Given/Received

Putting it Together Continued…

Guidelines for Patient Care Coordinator (PCC)

• Review Patient Care Plan Parts I & II

• Update PCC Kardex (if uses)

• Verbal Handover

• Highlight Patient Assignment

• Nurse Assigned In-Charge Duties on Night Shifts

Putting it Together Continued…

Guidelines for Transfer of Patient

• To areas using Handover

• To areas not using Handover

How It Works…

• Off going staff gives a verbal report to the oncoming staff regarding any urgent or emergent information

• On coming staff completes safety round on assigned patients

• Staff converge and make their individual work lists and read the written component of their patient’s report

How it Works Continued…

• Staff complete a regrouping to share patient information that is necessary for all unit staff to know to ensure safe care of all patients.

• Staff then begin shift

• Update Patient Care Plans (Parts I and II) and nursing census as shift progresses

How it Works Continued…

Verbal Report

Safety Round

Written Report

Regroup

Work

Written Report

Challenges

Challenges Continued…

• Nursing Census not completed properly, leaving staff feeling that they did not have sufficient information on all patients

• Staff felt that there was not sufficient in-servicing

• Patient Care Coordinator(s) report

• Verbal Report between Off-Going Staff and On-Coming Staff, within unit, break relief, questions regarding confidentiality

Challenges Continued…

• Updating Kardex (Nursing Care Plan Part I)

• Written Report Contents (and readability)

• Safety Round Compliance

• Tardiness

• Narcotic Count

• Extra Reports

Solutions

• Nursing Census: Clarification of how to enter data; census data compiled so just need to maintain

• In-Servicing: Information Sessions provided for each side of the shift

• Verbal Report: Reinforce Guidelines for verbal report between off-going and on-coming staff, and within the unit. Some units use patient care summary, or what is important to each specific unit to guide the regroup report within the unit.

Solutions Continued…

• PCC Report: Varies Unit by Unit

• Care Plan Updating: Reinforce this • Written Report Contents (and readability):

Reinforce Guidelines

• Safety Round Compliance

• Tardiness: PCC/DM

• Narcotic Count: Assign Nurse to do counts

Solutions Continued…

• Extra Reports: One unit keeps x 2weeks, most erase

Evaluation

Our Performance Measures

Staff Satisfaction 2009 (Percentages)

86

104

0

10

20

30

40

50

60

70

80

90

100

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isfi

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ery

Sat

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ery

Dis

sati

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d

Level of Satisfaction

Pe

rce

nta

ge

of

Sta

ff S

urv

ey

ed

Handover Report

Our Performance Measures Cont’d

Surgery Program Handover Report Audits 2009(Percentages)

36

99 100 98

1

100

64

1 0 2

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Criteria(OCS On- Coming Staff OGS Off-Going Staff TOA Transfer of Accountability)

Pe

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YesNo

Our Performance Measures Cont’d

Benefits identified by staff:

• Decreased delay in getting to the bedside

• Increased time at the bedside

• Decreased call bells at the beginning of the shift

• Patients are being received in transfer from ER and

Our Performance Measures Cont’d

• Recovery Room with less delay

• Post operative patients are mobilized earlier

• Have more time to spend speaking with the patients

• Increased staff and patient satisfaction

• Early identification of errors/occurrences

Our Performance Measures Cont’d

Disadvantages noted by staff…..

• No time to drink coffee at the beginning of their shift

Next Steps

• Information Sharing

• Providing assistance to initiate handover in other areas

Strutting Our Stuff

• Handover has been initiated successfully throughout 8 surgical units and 6 medical units of Eastern Health

• Safer Healthcare Now! Recognition

• ARNNL Recognition

• Article to be published in The Current in January 2010

Questions?

Thank You!

References

Accreditation Canada www.cchsa.ca accessed on January 20, 2009

Arora V., & Johnson, J. (2006). A model for building a standardized hand-off protocol. The joint Commission Journal on Quality and Patient Safety, 32 (11), 646- 655.

Canadian Patient Safety Institute. Effective teamwork and communication to enhance patient safety. Retrieved October 1, 2009, from http://www.patientsafetyinstitute.ca/English/toolsResources/teamworkCommunication/Pages/default.aspx

Penney, J. (2008). Literature review of nursing handover. Unpublished.

Schroeder, S.J. (2006). Picking up the PACE: A new template for shift report.

Nursing 2006, 36(10), 22-23.

Schroeder, S.J. (2006). Improving intershift handoff and patient safety. LPN 2007, 3(2), 22-23.

Contact Information

Lynnette McCarthy Woodrow

Division Manager Head and Neck Surgery,

Vascular Surgery, and Vascular Lab (Acting)

St. Clare’s Mercy Hospital

(709) 777-5716

Lynnette.MccarthyWood@easternhealth.ca